Provider Demographics
NPI:1245003789
Name:BELLEVILLE, KAREN MARGARET
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARGARET
Last Name:BELLEVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD WEST ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1011
Mailing Address - Country:US
Mailing Address - Phone:413-210-5978
Mailing Address - Fax:
Practice Address - Street 1:356 SEWALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2850
Practice Address - Country:US
Practice Address - Phone:413-610-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1611246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other